Michael Archuleta: 4 Things Startups Should Know about Rural American Healthcare Innovation

Prime Health is working with leaders like Michael Archuleta to improve Rural Health in Colorado

Rural areas are historically perceived as a harder market for healthcare startups: They have tighter margins, and recently many safety net and rural hospitals have closed. Yet rural areas are most in need of companies that can establish a lasting presence. In Colorado, groups like Prime Health are dedicated to improving healthcare in rural parts of the state. 

I spoke with Michael Archuleta, who serves as the CIO for Mt. San Rafael Hospital in Colorado and is a judge for the Prime Health Challenge; Archuleta is a leader in digital and healthcare excellence, who cautions not to overlook rural hospitals as incubators for new technology in the health sector.  “I really think that some individuals don’t understand the needs of rural america,” Archuleta says. “We are in rural America, but there are some really progressive facilities that are doing really well with initiatives.” Here are four great reasons Archuleta gives for celebrating rural hospitals:


We are a digital company delivering healthcare. Not a hospital.

At the end of the day it comes down to the culture of the organization. In healthcare, we’ve always been behind the curve when it comes to technology advancements. That is strange, because here we are saving lives, but we are behind the finance industry and oil and gas in innovation.

Even seeing how the CIO role in healthcare organizations has evolved is encouraging. We have transformed the current role–from being a cost center and department, to being a profit center and a strategic member of the organization.  Technology can be an asset and bring profit for rural hospitals, and that savings starts with an internal culture welcoming heath at the speed of technology.

If you are talking about innovation in rural america without the baseline of building those core culture values of progress and being a digital company, we will fall behind. The internal disruption has to happen in order for us to continue progressing. The team and the culture come first. Technology is a tool to create and improve efficiencies within what we are trying to do.

If we can’t model the drive and motivation of technology companies or large healthcare systems with robust funding, how can we continue to progress in the digital age of healthcare? Great culture allows small organizations and rural hospitals to be agile and competitive.


A lot of people don’t like change–when I came here, we didn’t even have an electronic health record. I remember going to the med-surg unit and there were nurses that had been documenting on paper. They saw me as the guy who was making them do records and adding more work. I had a laser focus on specific reasons for improvement. My hospital, Mt San Rafael Hospital, has done HIMSS verification and most wired

All the “technology” initiatives that have improved business have also improved revenue. This focus on technology improving healthcare has Mt. San Rafael Hospital to stand out. We were laser focused on HIMSS analytics. Our hospital is Stage 6, which only 34 percent of organizations have accomplished in the entire healthcare sphere. You need the fire of cultural change and to understand how to drive initiatives in order to have technology be an organizational asset. Providers support initiatives in technology that improve patient care.

I sit on a committee for the southeastern Colorado area. The critical element for partners is meeting the needs that rural organizations are faced with. We use a PCO, or ROI from our key performance indicators. People need that visualization of where things are before an initiative starts and where things are after. If an initiative doesn’t match our goals and performance indicators, even if it’s great technology, we do not invest in it.

If startups can illustrate to healthcare organizations their specific gain and what it’s measuring, it can be eye opening. In a small facility it’s hard to fund a technology driven project. People want to know, why are we doing this? Are we improving patient outcomes? Like cybersecurity–we need a culture of awareness.


Even though we are a small organization we don’t have to think small.  We have always started with patient-centric needs and these are the needs for our community and patients. Our hospital supports the Prime Health Challenge in facilitating that collaboration.

There is such a problem of deprivation for certain communities, particularly as far as mental health care is concerned. There aren’t enough services here in rural Colorado–we need applications and technology tools that hospitals in big cities have access to. However, you can see an increase of telemedicine. 

Rural hospitals are looking for companies that are successful at improving telemedicine, getting more mental healthcare access, continuity of care between facilities, and better ways of focusing on interoperability.

A lot of our payment is through medicaid: Rural hospitals have a high rate of individuals with no insurance, and Colorado in particular has a high population of transients throughout the city since they legalized marijuana. You start seeing a larger population of transients coming into the area, and you have to provide services, but in many cases it’s hard to find out if patients even have insurance. 

Smaller facilities aren’t always connected–look at federal programs paying for 65% of telecommunications costs. At the hospital, we just did a fiber improvement.We have 2 ISPs and 1 LAN–the site to site connections are built–and we are increasing connectivity. Always grow the initiatives–if they ever go to 5G, we can go through a 10G pipe and their technology plan is long term. A lot of rural organizations don’t know about the healthcare connect fund, wherein the federal government is paying for 65% of your telecommunications investment–that is a lot, and it’s really helped us grow, to take advantage of this program.

Rural America has a lower life expectancy. Patients in rural America aren’t able to get the best medical care that they need. Currently, one of the big scares is that a lot of facilities are closing. That is a major issue. Investors need to come in knowing what a high-stakes game this is for people who live, obtain and provide health care in rural areas. 


I am looking for a business partner, not a vendor. A vendor sells me an application, but a business partner says, “Your success is my success”–holding your hand and showing strong initiatives.

When an organization is approaching a facility that is not as progressive and hasn’t adopted the digital process, I ask myself, “What are some of the quality based initiatives that this organization needs from me?” Some of the small organizations fear proof of concept agreements. When a rural hospital looks at a startup- they know that many startups fail. They ask themselves: Does the startup have a strong financial background? Where they will be there 5 or 10 years down the line? The hospital is taking a risk every time, and showing the startup can meet specific needs is key.

Many startups fail, and rural hospitals and healthcare in general can’t afford to invest in a partner that will need to be replaced a few years down the road. Building lasting success is key. If you want to succeed in rural healthcare, include rural hospitals as partners in building your solution. Someone that lives and sees the issues you are trying to solve has invaluable insight.

Startups needs to look at the funding options. Ask yourself, “Can we incorporate into necessary programs?” You should know about initiatives and funding that are in place. Before you meet with a group you should do your homework about the potential funding sources you will have. There are so many opportunities that startups can use to help improve health. Not knowing what they are before your meeting shows a lack of interest.

We are all here for one reason–that reason is patient care and patient outcomes. The patient is our CEO; thus, the patient should determine if you keep their loyalty. You need to improve on their care. 

About Michael Archuletta
Michael takes risks and loves dealing with startups. You can be responsible for the risk and for the initiatives. For Startups looking to succeed in Rural Colorado, Look at the culture and see where the overall senior management team is. His team uses size to create more agility and possibility. They utilize the startups as a tool and recommend that companies create a really aggressive proof of concept and show benefit from before and after.

About the author

Janae Sharp

Janae Sharp

Healthcare as a Human Right. Physician Suicide Loss Survivor.
Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. Founder of the Sharp Index.
twitter: @coherencemed